MEDICARE: DR. JAMES A. RICHARDSON O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	192	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z114997	OTHER	AZ	PTAN
2	Z125427	OTHER	AZ	PTAN
3	1154381879	OTHER	AZ	NPI
4	1760692768	OTHER	AZ	NPI

General Provider Information

NPI Number	:	1154381879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES A. RICHARDSON O.D.

Provider Business Mailing Address
First Line	:	2840 HWY 95
Second Line	:	SUITE 108
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7792
Country	:	US
Telephone Number	:	928-758-2020
Fax Number	:	928-758-4544

Provider Business Practice Location Address
First Line	:	2840 HIWAY 95
Second Line	:	SUITE 108
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-7792
Country	:	US
Telephone Number	:	928-758-2020
Fax Number	:	928-758-4544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	11/25/2008

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